Managing risk in a healthcare system is challenging. That is because hospital risk managers juggle many responsibilities to keep their organizations safe. Specifically, they are responsible for identifying high-risk areas that could cause harm to patients, visitors, and employees; implementing programs to avert risks; and managing a robust reporting process for adverse events that do occur.

But of all of their responsibilities, one of the most important is focusing on improving patient safety — for both the health of the patient and to minimize the financial risk an adverse event poses to the health system.

Why the Need to Improve Patient Safety?

Improving patient safety improves overall patient outcomes. But there are additional incentives for avoiding adverse events. The reasons are as follows:

Declining Reimbursements. All hospitals are concerned about their patients’ safety. But patient safety has taken on even greater urgency now that it affects the hospital’s bottom line as a result of reimbursement reform under the 2010 Affordable Care Act (ACA). In specific, the Hospital-Acquired Condition (HAC) Reduction Program under the ACA aims to reduce the occurrence of preventable conditions that occur after a patient enters a healthcare facility. Before the HAC program went into effect, hospitals weren’t penalized financially if adverse events happened to patients while they were in the hospital. Beginning in 2015, however, Medicare instituted a maximum one percent penalty for hospitals in the higher quartile for adverse events that did not present on a patient’s admission to the facility but did occur during a hospital stay.

Reputation. Choosing a hospital based on its reputation has seen explosive growth in the last ten years. As a result, there is a heightened focus on patient safety because more information is available to consumers about a hospital’s performance than ever before. Now that consumers are more accountable for their own healthcare choices, they are starting to research hospital data before choosing where to go for care. With websites like Medicare’s Hospital Compare, it’s easy for consumers to see how hospitals rate in areas such as patient experiences, surgical complications, death rates, hospital-acquired infections, and whether or not care delivery is timely and effective. Consumers use this easily accessible data to determine where — or where not — to get treatment.

The Need to Accurately Identify Reportable Events

Because hospitals have a lot to lose — in terms of both reimbursements and reputation — accurate identification of adverse events is critical. Hospitals, and particularly risk managers, devote a lot of time and energy to determining whether an incident constitutes a reportable event. In fact, all incidents are evaluated and vetted by multiple departments to determine whether the event is indeed reportable.

Unfortunately, most hospitals do not have tools in place that enable all departments involved with the event to review the associated data in one central repository. Nor are the departments able to follow the event’s progress through the risk management workflow. For example, let’s take the case of what typically happens when there is a patient fall. A nurse charts the fall, but there is only a certain amount of data that goes into the EMR (the fact is that a lot of risk data isn’t captured in the EMR). The event is then triaged by multiple departments: typically quality, nursing, and risk. Each department must review the event, provide feedback, and sign off as to whether or not they believe the event should or should not be classified as reportable.

When a workflow requires multiple reviewers, risk managers face a real challenge because they likely don’t have a streamlined way to collaborate with everyone involved in the decision. They might be limited to communicating via email and meetings as a way for everyone to analyze the information, share feedback, and monitor the process. With such a time-intensive approach to reviewing each event, the evaluation process for a single event can take up to six to eight weeks and many management staff hours.

The Solution for Risk Managers — A Healthcare EDW

Risk managers need adverse event information to be accessible in a central location where all collaborating departments can see it simultaneously. That is where a healthcare enterprise data warehouse (EDW) comes into play. The principal function of an EDW is to serve as a single source of truth by aggregating and validating data from various source systems across an organization so everyone has access to the same accurate data.

Once the EDW platform is in place, the health system can add a simple data entry application tool that runs on top of the EDW but stores the data in the EDW. This web-based data collection tool enables users like risk managers to create simple forms and publish those forms to a set of collaborators. Instead of communicating with a group of collaborators via email and attempting to capture feedback in a spreadsheet, risk managers — and everyone else involved in the process — can see and comment on the adverse event in one location and in a timely manner.

In addition to being able to view information about the event, there are additional benefits to using an EDW with a data entry application tool. Each department’s representative can submit and save his or her feedback about the event, which is then accessible to the other parties involved. Everyone can also see who has evaluated and signed off on the event. This solution not only streamlines the review process; it also makes the process more accurate. By replacing manual work with automation through the EDW, the likelihood of data entry errors are reduced because risk managers no longer need to consolidate information from various emails and spreadsheets.

This approach to risk management adds more functionality than what’s available from the many standalone risk management applications currently on the market. While such applications are able to track events, that’s the extent of what they can do. They aren’t able to monitor the evaluation and investigation process for each risk event, and their usability is limited to drop down answers that aren’t robust enough to capture the unique details of each event. In other words, standalone risk management applications just track the event and the outcomes of the event.

Proactive Risk Management in Healthcare

Beyond streamlining workflows and providing more accurate information, an EDW empowers risk managers to be more proactive. Risk management is, by nature, a reactionary process — an event occurs, and risk managers respond to it. Completely eliminating the reactive nature of this work is unlikely, but an EDW makes it possible for risk managers to be more proactive with managing potential risky events. Specifically, the EDW enables trending and surveillance of adverse events. With this information in hand, risk managers can look at the relationship between correlation and causation. For example, is there an increase in the number of falls at night? Are there more adverse drug events on the weekend when the pharmacy isn’t as fully staffed? How does risk increase or decrease based on staffing levels? In short, surveillance and analytics enable hospitals to identify their risk points.

As risk managers become more proactive, they can collaborate in positive ways with departments throughout the hospital. And this kind of positive collaboration can drive a much-needed culture change that reduces the stigma associated with a risk event. Let’s face it: risk management is typically viewed as a punitive process. If a department is being assessed by a risk manager, it typically means they’ve done something wrong. But if departments shift their perspective to view risk managers as collaborative partners who are there to help them avoid the adverse event in the first place, the hospital’s culture as a whole will become less reactionary. The end result? The culture will transform into one where teams work together to proactively address patient safety issues. This not only benefits patients but also the hospital’s bottom line.

Risk Management in the Era of Accountable Care

Managing risk is difficult, especially when risk managers don’t have the right tools for collaboration and they can’t easily access all of the necessary information in a centralized location. Risk management can be significantly improved when departments and risk managers are able review, tag, and follow all of a reportable event’s data in one central repository. An EDW provides such a repository and offers a single source of truth that all collaborators can rely on for their assessment of each event. With the addition of a data entry application tool on top of the EDW, risk managers and their collaborators gain the ability to streamline their workflow processes, reduce manual errors, and proactively recommend risk management improvements — all of which are critical components to increasing patient safety in this environment of Accountable Care.

I’d love to hear from you about your risk management challenges and successes. If you’re a healthcare risk manager, can you see the benefit to having access to a single source of truth for your reportable events?

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